股骨颈骨折患者围术期血清骨硬化蛋白及Dickkopf-1蛋白水平变化规律及意义

Dynamic change rule of serum sclerostin and Dickkopf-1 in femoral neck fracture patients and their clinical significance

目的探讨股骨颈骨折患者围术期血清骨硬化蛋白（SOST）和Dickkopf-1（Dkk-1）蛋白的变化规律及临床意义。方法选择2014年8月~2015年8月于南京大学医学院附属鼓楼医院行股骨颈骨折关节置换术患者45例为实验组,采集患者术前1 d及术后1、3、5 d空腹静脉血样;选择同期45例年龄、性别、体重指数配对的健康体检者作为对照组。检测两组患者血清中SOST和Dkk-1水平并进行分析。结果实验组患者术前血清SOST为1.3（1,2.39）ng/m L,Dkk-1为（2.87±1.08）ng/m L,明显低于照组[SOST为1.95（1.64,2.64）ng/m L,Dkk-1为（3.66±1.21）ng/m L]（P〈0.01）。实验组患者围术期血清SOST与Dkk-1均呈先升高后下降的趋势,且两者呈正相关（P〈0.05）。血清SOST在术后1 d迅速升高至1.49（1.07,1.99）ng/m L,术后3 d降至1.3（0.97,2.1）ng/m L,术后5 d迅速降至1.01（0.91,1.55）ng/m L,与术前比较差异均有统计学意义（P〈0.05）。血清Dkk-1在术后1 d显著升高至（3.04±1.04）ng/m L,术后3 d升至（3.07±1.19）ng/m L,术后5 d降至（2.93±1.08）ng/m L,但术后3、5 d值与术前比较,差异无统计学意义（P〉0.05）。结论围术期股骨颈骨折关节置换术患者血清SOST与Dkk-1均呈先升高后下降的趋势。血清SOST术后变化较DKK-1更敏感,趋势更显著,可作为骨折后机体成骨能力的标志物及潜在的药物治疗靶点。

Objective To explore the dynamic change ruleof serum Sclerostin（SOST） and Dickkopf-1（Dkk-1） in femoral neck fracture patients and their clinical significance. Methods From August 2014 to August 2015, in Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, 45 femoral neck fracture patients were selected as experiment group, the fasting peripheral blood samples were collected at 1 d before surgery and 1, 3, 5 d after surgery; at the same period, 45 healthy outpatient medical examination which persons matched in age, sex and BMI were selected as control group. Serum concentrations of SOST and Dkk-1 of two groups were decected and analyzed.Results Before surgery the levels of serum SOST and Dkk-1 of patients in experiment group were lower than those in control group [1.3（1, 2.39）,（2.87±1.08） ng/m L vs 1.95（1.64, 2.64）,（3.66±1.21） ng/m L, P 0.01]. At perioperative period, levels of serum SOST and Dkk-1 of patients in experiment group presented the trend of rising after the surgery then decreased gradually, and there was positive correlation between them（P 0.05）. The serum levels of SOST rapidly increased to 1.49（1.07-1.99） ng/m L at 1 d after surgery, then decreased to 1.3（0.97, 2.1） ng/m L at 3 d after surgery,and rapidly decreased to 1.01（0.91, 1.55） ng/m L at 5 d after surgery, compared with that before surgery, the differences were statistically significant（P 0.05）. The serum levels of Dkk-1 rapidly increased to（3.04±1.04） ng/m L at 1 d after surgery, then increased to（3.07±1.19） ng/m L at 3 d after surgery, and decreased to（2.93±1.08）ng/m L at 5 d after surgery,but those at 3, 5 d after surgery were compared with that before surgery, the differences were not statistically significant（P 0.05）. Conclusion The perioperative levels of serum SOST and Dkk-1 show the trend of rising after the surgery then decreased gradually. But the serum change and the trend of SOST is more sensitive and obvious than that of Dkk-1. So serum concentrations of SOST may be a marker of osteogenesis and a potential therapeutic target after fracture.